1. Melody Anthony, MS Director Provider Services
SoonerCare Choice PCMH 3rd State Consortium to Advance Medical Homes in Medicaid and CHIP March 31, 2011
Melody Anthony, MS
Director Provider Services

2. New SoonerCare Choice PCMH
“Unbundled” to incorporate PCMH principles
Monthly Case Mgmt / Care Coordination Fee
Peer grouped by type of panel and capabilities of practice
Office visit and service based component
Fee for service
Expanded Performance Component (SoonerExcel)
Transitional Payments in 2009 for first year
2 years of planning resulted in our program moving to the PCMH model. We did this at the providers request 2 2 2

3. SoonerCare Choice PCMH PCP Network: Feb 2011
1,494 PCPs at
831 sites
with
1,169,468
total member
capacity
255
PCPs
have been
added to the
network
42%
Member
capacity
being utilized
454,112
members are
enrolled
statewide
SoonerCare choice is 64% of total enrollment.
Programs Total Enrollment = 720,000 3 3 3 3

4. SoonerCare Choice PCMH: PCP Tier Summary
January 2009
Tier 1 = 445
Tier 2 = 223
Tier 3 = 31
Total = 699
February 2011
Tier 1 = 551
Tier 2 = 225
Tier 3 = 55
Total = 831
January 09 total = 699
February 2011 = 831
Our goal is to move all tier upward. Most of our new provider choice level 1 until they get a better understanding of our medical home concept
June
Payment Tier Code Count
Tier 1 521
Tier 2 213
Tier 3 45
Total = 779
Tier count is determined by provider location 4 4 4 4

5. SoonerCare Choice by Calendar Year
Does It Work?
HEDIS Measures
SoonerCare Choice by Calendar Year
2001
2002
2003
2004
2005
2006
2007
2008
2009
Annual Dental Visit (Combined rate < 21 years) (ADV)
41.60%
46.60%
51.20%
53.60%
56.60%
56.30%
57.20%
59.70%
62.10%
Breast Cancer Screening (BCS)
N/A
29.80%
29.20%
31.90%
33.80%
35.10%
38.30%
43.00%
Cervical Cancer Screening (CCS)
32.60%
34.50%
43.50%
42.00%
43.70%
44.40%
Children's Access to PCP (CAP) (at least one PCP visit)
12-24 months
88.10%
89.50%
90.80%
91.40%
91.60%
94.30%
94.10%
96.20%
7-11 yrs
76.70%
79.00%
79.20%
77.30%
81.50%
80.40%
80.80%
82.70%
87.60%
Adult Access to Preventive/Amb Health Services (AAP)
20-44 yrs
68.40%
68.80%
69.80%
71.60%
72.00%
74.90%
75.60%
78.40%
83.30%
45-64 yrs
80.30%
81.30%
81.80%
82.80%
84.20%
85.20%
86.80%
89.70%
Significant increase from previous year
Significant decrease from previous year
It works we improved in 16 of 22 HEDIAS measures. These are the one with the greatest improvement 5

6. SFY 2009 CAHPS® Child Health Survey
High satisfaction steady across six quality measures
Statistically significant improvement in 2 areas
Rating increased from 8.24 to 8.73
Overall rating of child’s health plan:
Rate increased from 51.89% to 70.28%
Always getting treatment quickly: 6

7. SFY 2010 CAHPS® Adult Health Survey
Rising satisfaction with health care and customer service
Statistically significant improvement in access to care
Rate increased from 52.01% to 59.58%
Always getting treatment quickly: 7

8. SoonerCare Choice PCMH: Member Inquiries
Jan-Dec 2008
Jan-Dec 2009
Jan-Dec 2010
Members
407,408
438,276
440,842
Access to Care
7,833
1,322
509
Same Day / Next Day Access to Care
1,670 13 4 8

9. Changes through 2010 Reduced per capita cost Provider Profiles
2008 $24.95
2010 $22.53
Provider Profiles
Statistically significant improvement in observed to expected ER visit ratio
Over 6.7M paid out through SoonerExcel since inception of the PCMH model
Average payment per provider $1,100.00
The reduction in cost was a pleasant surprise. The transition of the payment methodology was based on budget neutrality. This reduction in per capita cost is in preventive and office visit codes 9